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SASTM Newsflash - Tuberculosis: China: Multidrug resistant

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TUBERCULOSIS - CHINA: MULTIDRUG RESISTANT

Heavily burdened by rising multidrug-resistant tuberculosis (MDR-TB), China now has nearly 120 000 new cases on the mainland each year, according to public health experts. That accounts for 25 percent of the world's total per year, according to statistics from the ChineseCenter for Disease Control and Prevention. MDR-TB is defined as TB, which is resistant to [at least] isoniazid and rifampicin, the most powerful 1st-line anti-TB drugs.

"MDR-TB needs more complicated diagnosis methods, longer and much more expensive treatment compared with common TB, which causes huge economic and human resource loss," said Chen Mingting, deputy director of the NationalCenter for Tuberculosis of China CDC. With no effective intervention, the number of MDR-TB patients in China is expected to reach 710 000 on the mainland by 2020, which would incur an economic loss of more than 99 billion yuan [about USD 16.1 billion] mostly in medical treatment, he said, citing previous studies by CDC. "That might upset social stability and harm economic development of the nation," he said.

Currently, the Chinese government provides free treatment for common TB but not for MDR-TB, which costs much more for treatment. To help enrich drug choices for MDR-TB, the State Food and Drug Administration has approved the new medicine Sirturo, by Xi'an Janssen Pharmaceutical Ltd.

Worldwide, about 1/3 of the total population is infected with the bacterium that causes TB [_Mycobacterium tuberculosis_], and nearly 4 percent of those newly infected are initially resistant to multiple drugs [called primary drug resistance], according to the World Health Organization. That means that resistant forms of the disease are being transmitted directly from people to people, medical experts said.

[Primary drug resistant TB results from the direct transmission of drug resistant TB from one person to another.]

Communicated by: ProMED-mail

[The WHO has reported that TB drug resistance data are available for 2/3 of all countries in the world. Cases of multidrug resistant tuberculosis (MDR-TB) (that is, tuberculosis that is caused by a strain of _Mycobacterium tuberculosis_ that is at least resistant to 2 of the most effective drugs used to treat TB, isoniazid (INH) and

rifampin) have been reported in 80 countries, in some instances in almost 30 percent of all newly diagnosed cases (that is, primary drug resistance) and some countries reporting MDR-TB in more than 65 percent of patients who have been previously treated for TB. High rates of drug resistance were reported in Belarus, Estonia, the Russian Federation, and Tajikistan. However, national representative data are lacking in many large countries with high TB burden, including India and several African countries. Routine drug susceptibility testing of all confirmed TB cases should be the goal, but there are very few laboratories to diagnose MDR-TB in developing countries, and only 34 countries and settings have a system in place to routinely test all patients with MDR-TB for 2nd-line anti-TB drug resistance.

The largest country that conducted a nationwide survey in the reporting period (2007-2010) was China, which conducted its 1st nationwide survey in 2007. The survey, which confirmed previously published estimates, based on extrapolation from subnational level data, found 5.7 percent of new TB cases and 25.6 percent of previously treated cases have multidrug resistance. For comparison, the corresponding percentages for the USA are 1.1 and 4.4, respectively.

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The content and opinions are neither pre-screened nor endorsed by the SASTM. The content should neither be interpreted nor quoted as inherently accurate or authoritative.

SASTM NEWSFLASH
The information provided in SASTM Newsflashes is collected from various news sources, health agencies and government agencies. Although the information is believed to be accurate, any express or implied warranty as to its suitability for any purpose is categorically disclaimed. In particular, this information should not be construed to serve as medical advice for any individual. The health information provided is general in nature, and may not be appropriate for all persons. Medical advice may vary because of individual differences in such factors as health risks, current medical conditions and treatment, allergies, pregnancy and breast feeding, etc. In addition, global health risks are constantly evolving and changing. International travelers should consult a qualified physician for medical advice prior to departure.

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The SASTM’s Mission is to guide the profession in all aspects relating to the practice of travel medicine,
liaise with the travel industry, consult with relevant authorities,
advise the public and collaborate nationally and internationally on all aspects relating to Travel Medicine.

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